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Cross-Cultural Evaluation of Health Status Using Item Response Theory

FACT-B Comparisons Between Austrian and U.S. Patients With Breast Cancer

Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, e-hahn{at}northwestern.edu

Bernhard Holzner

Department of Psychiatry, University Hospital, Innsbruck, Austria

Georg Kemmler

Department of Psychiatry, University Hospital, Innsbruck, Austria

Barbara Sperner-Unterweger

Department of Psychiatry, University Hospital, Innsbruck, Austria

Stacie A. Hudgens

Learning Point Associates

David Cella

Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University

To make meaningful cross-cultural comparisons of health-related quality of life (HRQOL) or to pool international research data, it is essential to create culturally unbiased measures that detect clinically important differences between patients. We evaluated the measurement properties of the Functional Assessment of Cancer Therapy-Breast (FACT-B) in 111 Austrian and 144 U.S. patients with breast cancer using item response theory (IRT) methods. A small number of items were identified as displaying statistically significant differential item functioning (DIF), suggesting possible measurement bias. The majority of the items functioned similarly between the two cultural groups. U.S. patients reported lower (worse) physical function and well-being compared with Austrian patients, higher (better) social/family well-being and similar emotional well-being, before and after adjustment for DIF. IRT and related measurement models provide useful methods for assessing cross-cultural equivalence and determining which items can be pooled across languages before analyzing HRQOL data. Determination of clinically significant cross-cultural differences will require additional investigation.

Key Words: cross-cultural comparisons • measurement bias • quality of life • Rasch measurement • item response theory

Evaluation & the Health Professions, Vol. 28, No. 2, 233-259 (2005)
DOI: 10.1177/0163278705275343


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